Volume 8,
Issue 5,
2002

Extracted from text ... EDITORIAL
Professor Christina Lundgren - Editor-in-chief
Our final issue of the SAJAA for 2002 contains a variety of articles, and hopefully there is something that will be of interest to everyone. We have looked at a variety of practical issues, ranging from patients on long term corticosteroid therapy, problems associated with arterial tourniquets, fever in pregnancy, beta blockers to "how to do" low flow anaesthesia.
Our first article is a comprehensive review by Krzysztof Kuczkowski on the choice of anaesthesia for the febrile parturient, a dilemma which faces us all at some time. What is ..

Extracted from text ... GUEST EDITORIAL
Ivan Joubert
Department of Anaesthesia, and Respiratory Intensive Care Unit, Groote Schuur Hospital
Correspondence:
e-mail: joubert@cormack.uct.ac.za
The case for Perioperative steroid supplementation
The issue of providing steroid supplementation, during the peri-operative period, for patients receiving steroid therapy has long been a hotly debated issue. In the Lancet of 1996, Levy1 wrote that, "The need for patients on long term steroid treatment to increase their dose of glucocorticoids when under stress is a principle that rests in one of the most tranquil corners of medical dogma". Reviewing the literature ..

Arterial tourniquets are widely used in limb surgery to reduce intra-operative bleeding, thereby providing for better operative
conditions. There are, however, a number of consequences, both localised and systemic, related to tourniquet use. While
these may be relatively benign in the healthy patient, they may be devastating in the patient with, for example, poor cardiac
reserve.

This review discusses the mechanisms of perioperative ischaemia and how β-adrenoceptor blockade may prevent it. The evidence for perioperative β-adrenoceptor blockers, their side effects and recommendations for their perioperative use are discussed.

The practice of volatile anaesthetic agent delivery using a fresh gas flow less than the minute volume has been with us since the early days
of anaesthesia. Its popularity has closely paralleled the introduction of new volatile anaesthetic agents, where the cost saving of using lowflow
is a prerequisite to affording a new, expensive agent.
The introduction of Desflurane and Sevoflurane in the South African market over the past few years, along with the 0028 code for lowflow
earlier this year has renewed interest in the technique. Some anaesthesia machines now come equipped with "econometers" designed
to achieve the optimal fresh gas flow, while also reassuring one that an adequate fresh gas flow is being delivered. With the widespread
availability of agent, CO&lt;sub&gt;2&lt;/sub&gt; and oxygen monitors the use of low-flow anaesthesia has become a predictable technique that can be titrated
against measurable results.